Nurse Specialty Spotlight: Neonatal Nursing

Neonatal nurses provide care for the tiniest humans – from those born prematurely before full gestation and with low birth weights to those born at all gestational ages and birth weights, but with medical conditions or critical illness.

Neonatal nursing is a specialty that many say brings tears of both joy and sorrow. It is not for the faint of heart, yet the rewards are so great they are often life changing. For neonatal nurses, their patients may be small, but the act of caring for them is profound.

“You really cannot anticipate the impact that you, as a nurse, have on the patients and families you care for and build relationships with in the NICU (Neonatal Intensive Care Unit),” says Tracy Park, MBA, BSN, RN, NICU Nurse Manager at Cleveland Clinic Hillcrest Hospital. “I recently had a family I cared for 26 years ago reach out to thank me for the impact I made on them – as young parents, on their career choices, and on how the entire experience of having a ’28-weeker’ set the foundation for their life.”

Park cared for the couple’s newborn daughter for 4 months in the NICU and today, the once neonate, is married, teaches Kindergarten and lives without any developmental or physical disabilities.

Park has been a NICU nurse since the onset of her nursing career in 1992. She says NICU patients and nurses are all superheroes. “A successful NICU nurse has a passion for the amazing neonate – babies who defy the odds and are stronger than you could ever imagine. It is truly a remarkable experience to take care of the smallest human being who has been born way too soon, wonder if they will survive, marvel that they do and then enjoy the visits parents make to show off their miracles after discharge. It is an amazing job that many couldn’t imagine doing,” she adds.

Denise Speer, MSN, RN, Director of Women’s and Children’s Services at Cleveland Clinic Fairview Hospital, who has 41 years of experience as a neonatal nurse, agrees.

“Once you become a neonatal nurse it is so much more than a job or even a career. It is a passion that you cannot get out of your heart,” Speer says. “I did try other types of nursing during a time I was working as a float nurse, but in those roles, I was never able to feel the way I felt about NICU patients and parents.”

A combination of critical thinking and scientific knowledge

Speer says the best NICU nurses are those who are advocates for their patients and patients’ parents/families. More than any other caregiver, NICU nurses need to understand their patients’ needs. To effectively do that, Speer says NICU nurses must have critical thinking skills and a strong scientific knowledge base. They must be able to assess the patient, determine what is happening and provide appropriate care.

Park and Speer note that providing quality, evidence-based care in the NICU is of the utmost importance. And, with a patient population who can’t communicate with words, it can be challenging.

“I’ve always enjoyed having to use my assessment skills to meet the individual needs of each patient to provide them the best care,” says Speer. “The baby cannot tell you what is wrong, and you have to figure it out, which is always a challenge.”

Neonatal nursing at Cleveland Clinic falls within Cleveland Clinic Children’s as well as Women’s and Children’s Services. Hillcrest and Fairview Hospitals have Level III NICUs and Cleveland Clinic main campus has a Level IV NICU, where nurses care for very high acuity patients.

The health system has developed a strong neonatology program in which efforts are made every day to standardize care across all neonatal units. All neonatal caregivers work collaboratively under the same policies, procedures and shared medical teams. This supports caregivers working within each Cleveland Clinic NICU because the routine care provided is the same at each location, which leads to improved outcomes.

At Hillcrest Hospital, 80 NICU nurses work collaboratively with their multidisciplinary team members, rounding on each patient every day to ensure the delivery of safe, quality care. The same process happens at Fairview Hospital, which employs roughly 85 neonatal nurses.

Rounds are started early in the morning and consist of physicians, neonatal nurses and nurse practitioners, respiratory therapists, pharmacists and social services, if appropriate. Caregivers go to the bedside of each patient and invite parents to participate in rounds to review the infant’s current state, discuss changes or concerns, and develop a plan of care for the next 24 hours. Depending on the patient’s condition, the standard is to provide care all at one time so the infant can rest between care episodes.

Parent education is a critical component of the job

In neonatal nursing, a highly important job responsibility is educating parents. Parents are encouraged to come and visit their infant in the NICU, and nurses spend a lot of time teaching parents how to care for their baby. Speer says when the infant is in critical condition, nurses may simply teach parents how to give mouth care, but as the patient progresses more is taught, including developmental cues.

She notes that interacting and working with parents requires great listening skills, as well as the ability to demonstrate compassion and empathy.

“Every parent comes to the NICU afraid and in shock. They are experiencing a crisis in their life and you have to be able to move them through it and help them cope,” Speer says. “I’ve always enjoyed taking care of the infant but taking care of the parents is what taught me compassion and empathy. I learned that listening is so important – you have to let families express their fears and concerns and offer them empathy and support.”

Park adds that parent education is crucial for a safe transition from hospital to home and says Cleveland Clinic’s NICU teams work diligently to build strong relationships and expert practice for positive patient outcomes and patient/family experiences.

A unique and rewarding career path

For those considering a career in neonatal nursing, Speer and Park suggest seeking opportunities to shadow NICU nurses or complete a neonatal practicum for added learning and experience. They also advise that neonatal nursing is a fast-paced specialty full of change so nurses wanting to pursue this career path should be able and willing to adapt to change.

In addition, they agree that the choice to become a neonatal nurse will be much more than a career – both defining it as a professional love.

“I truly love this career and am amazed every day by the dedication and advances our specialty has made to create these special NICU families. It is an opportunity to witness true miracles and truly make an impact,” says Park.

Similarly, Speer says: “It is a gift to work with families at this point in their lives and I feel so lucky to have had these experiences – they have made me a better person.”

Happy Year of the Nurse to all neonatal nurses!